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High-dose therapy and autologous hematopoietic progenitor cell
transplantation for recurrent or refractory Hodgkin's disease: analysis of
the Stanford University results and prognostic indices
SJ Horning, NJ Chao, RS Negrin, RT Hoppe, GD Long, WW Hu, RM Wong, BW Brown and KG Blume
Department of Medicine, Stanford University Medical Center, CA, USA.
One hundred nineteen patients with relapsed or refractory Hodgkin's disease
(HD) received high-dose therapy followed by autologous hematopoietic
progenitor cell transplantation. Three preparatory regimens, selected on
the basis of prior therapy and pulmonary status, were employed. Twenty-six
patients without a history of prior chest or pelvic irradiation were
treated with fractionated total body irradiation, etoposide (VP) 60 mg/kg
and cyclophosphamide (Cy) 100 mg/kg. Seventy-four patients received BCNU 15
mg/kg with identical doses of VP and Cy. A group of 19 patients with a
limited diffusing capacity or history of pneumonitis received a novel
high-dose regimen consisting of CCNU 15 mg/kg, VP 60 mg/kg and Cy 100
mg/kg. Twenty-nine patients (24%) had failed induction therapy and 35 (29%)
had progressive HD within 1 year of initial chemotherapy. At 4 years
actuarial survival was 52%, event-free survival was 48% and freedom from
progression (FFP) was 62%. No significant differences were seen in survival
data with the three preparatory regimens. Six patients died within 100 days
of transplantation and 5 died at a later date of transplant-related
complications. Secondary malignancies have developed in 6 patients,
including myelodysplasia/leukemia in four patients and solid tumors in two
patients. Regression analysis identified systemic symptoms at relapse,
disseminated pulmonary or bone marrow disease at relapse and more than
minimal disease at the time of transplantation as significant prognostic
factors for overall and event-free survival and FFP. Patients with none of
these factors enjoyed an 85% FFP at 4 years compared with 41% for patients
with one or more unfavorable prognostic factors (P = .0001). Our results
confirm the efficacy of high-dose therapy and autografting in recurrent or
refractory HD. Although longer follow-up is necessary to address ultimate
cure rates and toxicity, our data indicate that a desire to reduce late
effects should drive future research efforts in favorable patients whereas
new initiatives are needed for those with less favorable prognoses.
Volume 89,
Issue 3,
pp. 801-813,
02/01/1997
Copyright © 1997 by The American Society of Hematology
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